F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Nellis Family Medicine Residency, Mike O'Callaghan Federal Medical Center, Nellis Air Force Base, NV, USA.
Am Fam Physician. 2017 Nov 15;96(10):656-663.
Herpes zoster, or shingles, is caused by reactivation of varicella zoster virus, which causes chickenpox. There are an estimated 1 million cases in the Unites States annually, with an individual lifetime risk of 30%. Patients with conditions that decrease cell-mediated immunity are 20 to 100 times more likely to develop herpes zoster. Patients may present with malaise, headache, low-grade fever, and abnormal skin sensations for two to three days before the classic maculopapular rash appears. The rash is usually unilateral, confined to a single dermatome, and typically progresses to clear vesicles that become cloudy and crust over in seven to 10 days. Herpes zoster can be treated with acyclovir, valacyclovir, or famciclovir, ideally within 72 hours of the development of the rash. Postherpetic neuralgia is the most common complication, occurring in about one in five patients. It is defined as pain in a dermatomal distribution sustained for at least 90 days after acute herpes zoster. Treatment is focused on symptom control and includes topical lidocaine or capsaicin and oral gabapentin, pregabalin, or tricyclic antidepressants. The varicella zoster virus vaccine decreases the incidence of herpes zoster and is approved for adults 50 years and older. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends this vaccine for adults 60 years and older, except for certain immunosuppressed patients.
带状疱疹，俗称缠腰龙，是由水痘带状疱疹病毒（varicella zoster virus）引起的，该病毒也是导致水痘的病原体。据估计，美国每年约有 100 万例带状疱疹病例，个体一生中的发病风险为 30%。细胞免疫功能下降的患者发生带状疱疹的风险要高出 20 至 100 倍。患者可能会出现不适、头痛、低度发热和异常皮肤感觉，持续 2 至 3 天，然后出现典型的斑丘疹样皮疹。皮疹通常是单侧的，局限于单个皮节，通常进展为清晰的水疱，在 7 至 10 天内变得浑浊并结痂。带状疱疹可以用阿昔洛韦、伐昔洛韦或泛昔洛韦治疗，理想情况下应在皮疹出现后 72 小时内开始治疗。带状疱疹后神经痛是最常见的并发症，约 1/5 的患者会发生。它被定义为急性带状疱疹后至少持续 90 天的疼痛，呈皮节分布。治疗侧重于症状控制，包括局部使用利多卡因或辣椒素，以及口服加巴喷丁、普瑞巴林或三环类抗抑郁药。水痘带状疱疹病毒疫苗可降低带状疱疹的发病率，已被批准用于 50 岁及以上的成年人。美国疾病控制与预防中心免疫实践咨询委员会建议，60 岁及以上的成年人接种该疫苗，但某些免疫抑制患者除外。
